Diabetic Patient Long-Term Care and Management Flashcards
What is key in the treatment of diabetic patients?
Key is control of blood pressure, lipids, insulin resistance, clotting risks not merely blood glucose
How is Type II differentiated from Type I diabetes?
Type II doesn’t have ketosis, insulin antibodies or beta cell antibodies and negative HLA association
What is Type II associated with?
Hyperosmotic hyperglycemia syndrome but not DKA
Recommendation I for treatment of DM-II?
When diet, exercise, weight loss and life style changes are not adequate to improve hyperglycemia then add oral pharmacologic therapy
Recommendation II for treatment of DM-II?
Initial pharmacologic therapy should be monotherapy with metformin
Recommendation II for treatment of DM-II?
When lifestyle changes and monotherapy with metformin fail to control hyperglycemia then add a second drug to metformin
What is the primary factor in determining fasting plasma glucose levels?
Hepatic glucose production (gluconeogenesis)
What do sulfonylurea agents mainly control?
Fasting (basal) hyperglycemia by raising basal levels of insulin
What does Acarbose do?
Effects postprandial response by delaying absorption of carbohydrates
What do short acting sulfonylurea agents such as Miglitol and nateglinide do?
Some effect on postprandial response but less ability to reduce overall A1c and little effect on basal sugar
What do metformin and TZD’s effect?
Production and clearance of glucose by effect on hepatic gluconeogenesis and effect on glucose uptake at muscle and adipose respectively
When is metformin and TZD’s have their major effect?
Fasting glucose and some effect on post prandial as well
When do incretin agents, DPP-4 inhibitors and incretin mimetics have their effect?
Fasting and post prandial blood sugar levels
When do SGLT-2 inhibitors have their effect?
Both fasting and postprandial glucose levels
When do incretin and amylin mimetics have their effect?
Fasting and postprandial glucose levels
